Current Trends in Reduction or Elimination of Aortic Impulse during Stent-Graft Deployment and Balloon Molding during TEVAR

Objectives: A survey was performed to assess what methods are used in clinical practice during TEVAR procedures for reduction or elimination of aortic impulse (REAI) to facilitate precise stent-graft placement and balloon molding.

Methods: A total of 50 physicians in Europe, Japan, Korea, and the United States completed a short, comprehensive questionnaire with 50 questions on an internet-based platform.

Result: For TEVAR deployment in the ascending aorta and the aortic arch 100% physicians used REAI, whereas 80.6% used it in the descending aorta. The most frequent REAI method used was rapid right ventricular pacing (ascending 74.2% vs. arch 45.3% vs. descending 22.6%), followed by pharmacological blood pressure reduction (ascending 11.1% vs. arch 40.6% vs. descending 51.6%) and venous inflow occlusion (ascending 11.1% vs. arch 10.9% vs. descending 3.2%), respectively. REAI is less often used for balloon molding (ascending 47.8 vs. arch 46.9% vs. descending 32%). Tip capture and non-occlusive deployment systems were frequently quoted as reasons for the non-use of REAI. General anesthesia was most frequently used (ascending 100% vs. arch 95.9% vs. descending 84.0%).

Conclusion: REAI is the fundament for both, stent-graft deployment and balloon molding in all thoracic aortic segments, with a decline in usage from proximal (ascending) to distal (descending). Rapid right ventricular pacing is the preferred REAI method used in TEVAR. REAI is less frequently used for balloon molding. Most procedures are performed under general anesthesia. The type of stent-graft and molding balloon used have an impact on the use or non-use of REAI.

Die Autoren geben an, dass kein Interessenkonflikt besteht.

Publikationsverlauf

Artikel online veröffentlicht:
19. Februar 2021